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With HPV-related head and neck cancers rising, focus on treatment and vaccination

With HPV-related head and neck cancers rising, focus on treatment and vaccination

Source: blogs.wsj.com/health
Author: Laura Landro

A form of head and neck cancer associated with the sexually transmitted human papillomavirus is on the rise, especially in men, the WSJ reports.

Fast-rising rates of oropharyngeal cancer — tumors in the tonsil and back-of-the-tongue area — have been linked to changes in sexual behavior that include the increased practice of oral sex and a greater number of sexual partners.

But HPV-positive cancer has also been reported in individuals who report few or no sexual partners. It may also be possible for the virus to be transmitted to an infant via an infected mother’s birth canal. An HPV vaccine is routinely recommended for girls because the virus can cause cervical cancer.

The rise in HPV-positive head and neck cancers is leading to a new focus both on treatment of the disease, and whether recommending routine vaccination for boys could prevent oral infections and cancers. (A CDC advisory panel said in 2009 that it was fine for boys to get the vaccine, but recommended against routine administration.)

Eric Genden, chief of head and neck oncology at Mt. Sinai Medical Center, tells the Health Blog that when treated appropriately, patients with HPV-positive cancers have an 85% to 90% disease-free survival rate over five years. By contrast, patients with HPV-negative head and neck cancers, which are often associated with smoking and drinking, typically have more advanced disease when the cancer is detected and face a five-year survival rate of only 25% to 40%, Genden says.

HPV-induced head and neck cancer responds well to almost all forms of cancer therapy including surgery, external beam radiotherapy and chemotherapy. At Mount Sinai, the use of robotic surgery and radiation –with no chemotherapy required — resulted in three-year survival rates of 90% and significantly improved quality of life for patients, its studies show. Robotic surgery is less invasive than non-robotic tumor surgeries, minimizing complications and recover time.

Philip Keane, a 52-year old photographer and father of three , had the surgery last July at Mount Sinai, followed by a six-and-a-half week course of radiation at Memorial Sloan-Kettering Cancer Center. Keane says he’s switched to a healthier diet, and didn’t develop many of the symptoms of radiation he was warned about, such as mouth or neck sores. He says that during his therapy, he was able to continue working and doing everything he did before he got sick, and is now cancer-free.

On the vaccine front, at a meeting next month the CDC plans to review data on the issue of the cost and benefits of routinely recommending HPV vaccination for boys.

Michael Brady, chair of the department of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio and chairman of the infectious disease committee for the American Academy of Pediatrics, says the AAP is awaiting any updates before changing its own policies: routine recommendation for girls at age 11 to 12 (with catch-up for teens and young women who have not received the vaccine, up to age 26 years) and a permissive recommendation for boys — meaning families or teens can get it if they ask for it.

Brady explains that the gender discrepancy for HPV vaccine occurred because initial studies for safety and effectiveness were done in females and the idea was a high coverage rate in females would result in protection of heterosexual males via herd immunity.

But low coverage of females by the vaccine means that there is minimal protection of heterosexual males, and there’s increasing evidence of the impact of HPV-related genital, oral and anal cancers in men. There is also no value in a female vaccine program for homosexual men. “All [this leads] to a realization that males would benefit from the HPV vaccine,” Brady says.

The CDC’s own permissive recommendation for young men allowed for payment through the Vaccines for Children program, and a Merck spokeswoman says more commercial insurers are paying for the vaccine for males. But Brady says vaccines with that level of recommendation tend to not be discussed at physician visits, and administration of HPV vaccine to males has been very low.

Moreover, while clear evidence of a cost benefit in girls was shown prior to the release of the vaccine, cost/benefit data for males are still being determined. “The more that people look; the more that it is clear that males would benefit by receiving the HPV vaccine,” Brady says. “The discussion is [over] whether it merits a routine recommendation.”